EyeMed administers all routine exams to determine if corrective lenses are required. It also dispenses hardware such as frames, lenses, and contact lenses based on the member's benefit. EyeMed is responsible for the provider network including contracting, credentialing, claims processing and payment, routine vision grievances, and claims appeals.*
*Exception: Medicare grievances and claims appeals are managed by EmblemHealth.
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Provider Manual
Chapter 27: Vision Services
There are no exempt members. EyeMed is the routine vision provider for all EmblemHealth members who have a routine vision care benefit, including our ASO members.
To determine if a member has routine vision coverage:
- See the member's Benefit Summary on our secure provider portal at emblemhealth.com/providers under the Member Management tab and Eligibility drop-down
- Contact EyeMed Customer Service at 800-521-3605
Participating EyeMed providers can log on to eyemed.com or call EyeMed to obtain member eligibility and benefit information.
Members must use an in-network EyeMed provider to get covered benefits for a routine exam. See the Directory chapter for EyeMed Customer Service contact information.
If you are a vision service provider and interested in joining EyeMed, visit this site or call EyeMed's provider service department at 800-521-3605.
See the chart for routine vision exam CPT codes, materials HCPCS, and diagnosis codes that should be billed to EyeMed. Claims submitted to EmblemHealth will be denied.
